Multiplex translaminar imaging in the spinal cord of behaving mice

While the spinal cord is known to play critical roles in sensorimotor processing, including pain-related signaling, corresponding activity patterns in genetically defined cell types across spinal laminae have remained challenging to investigate. Calcium imaging has enabled cellular activity measurements in behaving rodents but is currently limited to superficial regions. Here, using chronically implanted microprisms, we imaged sensory and motor-evoked activity in regions and at speeds inaccessible by other high-resolution imaging techniques. To enable translaminar imaging in freely behaving animals through implanted microprisms, we additionally developed wearable microscopes with custom-compound microlenses. This system addresses multiple challenges of previous wearable microscopes, including their limited working distance, resolution, contrast, and achromatic range. Using this system, we show that dorsal horn astrocytes in behaving mice show sensorimotor program-dependent and lamina-specific calcium excitation. Additionally, we show that tachykinin precursor 1 (Tac1)-expressing neurons exhibit translaminar activity to acute mechanical pain but not locomotion.

Single-domain near-infrared protein provides a scaffold for antigen-dependent fluorescent nanobodies

Small near-infrared (NIR) fluorescent proteins (FPs) are much needed as protein tags for imaging applications. We developed a 17 kDa NIR FP, called miRFP670nano3, which brightly fluoresces in mammalian cells and enables deep-brain imaging. By exploring miRFP670nano3 as an internal tag, we engineered 32 kDa NIR fluorescent nanobodies, termed NIR-Fbs, whose stability and fluorescence strongly depend on the presence of specific intracellular antigens. NIR-Fbs allowed background-free visualization of endogenous proteins, detection of viral antigens, labeling of cells expressing target molecules and identification of double-positive cell populations with bispecific NIR-Fbs against two antigens. Applying NIR-Fbs as destabilizing fusion partners, we developed molecular tools for directed degradation of targeted proteins, controllable protein expression and modulation of enzymatic activities. Altogether, NIR-Fbs enable the detection and manipulation of a variety of cellular processes based on the intracellular protein profile.

Phosphatidylserine Exposure Controls Viral Innate Immune Responses by Microglia

Microglia are the intrinsic immune sentinels of the central nervous system. Their activation restricts tissue injury and pathogen spread, but in some settings, including viral infection, this response can contribute to cell death and disease. Identifying mechanisms that control microglial responses is therefore an important objective. Using replication-incompetent adenovirus 5 (Ad5)-based vectors as a model, we investigated the mechanisms through which microglia recognize and respond to viral uptake. Transgenic, immunohistochemical, molecular-genetic, and fluorescence imaging approaches revealed that phosphatidylserine (PtdSer) exposure on the outer leaflet of transduced cells triggers their engulfment by microglia through TAM receptor-dependent mechanisms. We show that inhibition of phospholipid scramblase 1 (PLSCR1) activity reduces intracellular calcium dysregulation, prevents PtdSer externalization, and enables months-long protection of vector-transduced, transgene-expressing cells from microglial phagocytosis. Our study identifies PLSCR1 as a potent target through which the innate immune response to viral vectors, and potentially other stimuli, may be controlled.

Orbital aspergillosis: voriconazole - the new standard treatment?

Background/Aim

To describe a case of invasive orbital aspergillosis and evaluate treatments and outcomes.

Methods

A case report and review of orbital aspergillosis treatment with voriconazole in the English language literature.

Conclusion

Amphotericin B with debridement is the current standard of care for orbital aspergillosis; however, its prognosis is unfavorable. When compared to amphotericin B, voriconazole demonstrates a survival benefit, has less systemic toxicity, and is better tolerated by patients. While a prospective trial comparing amphotericin B to voriconazole in orbital aspergillosis is not feasible, there is evidence to support the use of voriconazole as primary therapy.

Molecular mechanisms of rhodopsin retinitis pigmentosa and the efficacy of pharmacological rescue

Variants of rhodopsin, a complex of 11-cis retinal and opsin, cause retinitis pigmentosa (RP), a degenerative disease of the retina. Trafficking defects due to rhodopsin misfolding have been proposed as the most likely basis of the disease, but other potentially overlapping mechanisms may also apply. Pharmacological therapies for RP must target the major disease mechanism and contend with overlap, if it occurs. To this end, we have explored the molecular basis of rhodopsin RP in the context of pharmacological rescue with 11-cis retinal. Stable inducible cell lines were constructed to express wild-type opsin; the pathogenic variants T4R, T17M, P23A, P23H, P23L, and C110Y; or the nonpathogenic variants F220L and A299S. Pharmacological rescue was measured as the fold increase in rhodopsin or opsin levels upon addition of 11-cis retinal during opsin expression. Only Pro23 and T17M variants were rescued significantly. C110Y opsin was produced at low levels and did not yield rhodopsin, whereas the T4R, F220L, and A299S proteins reached near-wild-type levels and changed little with 11-cis retinal. All of the mutant rhodopsins exhibited misfolding, which increased over a broad range in the order F220L, A299S, T4R, T17M, P23A, P23H, P23L, as determined by decreased thermal stability in the dark and increased hydroxylamine sensitivity. Pharmacological rescue increased as misfolding decreased, but was limited for the least misfolded variants. Significantly, pathogenic variants also showed abnormal photobleaching behavior, including an increased ratio of metarhodopsin-I-like species to metarhodopsin-II-like species and aberrant photoproduct accumulation with prolonged illumination. These results, combined with an analysis of published biochemical and clinical studies, suggest that many rhodopsin variants cause disease by affecting both biosynthesis and photoactivity. We conclude that pharmacological rescue is promising as a broadly effective therapy for rhodopsin RP, particularly if implemented in a way that minimizes the photoactivity of the mutant proteins.

Drug resistance and neurotransmitter receptors of nematodes: recent studies on the mode of action of levamisole

Here we review recent studies on the mode of action of the cholinergic anthelmintics (levamisole, pyrantel etc.). We also include material from studies on the free living nematode Caenorhabditis elegans. The initial notion that these drugs act on a single receptor population, while attractive, has proven to be an oversimplification. In both free living and parasitic nematodes there are multiple types of nicotinic acetylcholine receptor (nAChR) on the somatic musculature. Each type has different (sometimes subtly so) pharmacological properties. The implications of these findings are: (1) combinations of anthelmintic that preferentially activate a broad range of nAChR types would be predicted to be more effective; (2) in resistant isolates of parasite where a subtype has been lost, other cholinergic anthelmintics may remain effective. Not only are there multiple types of nAChR, but relatively recent research has shown these receptors can be modulated; it is possible to increase the response of a parasite to a fixed concentration of drug by altering the receptor properties (e.g. phosphorylation state). These findings offer a potential means of increasing efficacy of existing compounds as an alternative to the costly and time consuming development of new anthelmintic agents.

Distraction Osteogenesis in Irradiated Rabbit Mandibles With Adjunctive Hyperbaric Oxygen Therapy

PURPOSE

The purpose of this study was to evaluate the effect of hyperbaric oxygen therapy on bone regeneration during distraction of irradiated rabbit mandibles.

MATERIALS AND METHODS

Twenty New Zealand white rabbits were randomly sub-divided into 4 groups. Group 1 served as control, group 2 received preoperative radiation therapy, group 3 received pre- and postoperative hyperbaric oxygen (HBO) therapy, and group 4 received preoperative radiation therapy and pre- and postoperative HBO therapy. All rabbits underwent a corticotomy of the left body of the mandible after placement of a distraction device. Distraction, at a rate of 1 mm/day and a rhythm of 1 turn/day, began after a 3-day latency period for 14 days. Thirty days after completion of the distraction protocol, the animals were euthanized, and histomorphometric and radiographic data of the distraction segments were obtained.

RESULTS

Histomorphometric analysis of new bone fill was greatest in the non-irradiated groups compared to groups receiving radiation therapy, regardless of HBO therapy (P = .03). Pre-corticotomy bone density measurements showed a significant increase in bone density over time (P = .0007). This resulted in a significant relationship between HBO therapy, radiation therapy, and time (P = .0050).

CONCLUSIONS

The results of the study support the use of HBO therapy during distraction osteogenesis. Any additional therapeutic benefit of HBO therapy in irradiated bone would require additional investigation.

Cyclin-dependent kinase activity is required at early times for accurate processing and accumulation of the human cytomegalovirus UL122-123 and UL37 immediate-early transcripts and at later times for virus production

Human cytomegalovirus (HCMV) infection leads to dysregulation of multiple cell cycle-regulatory proteins. In this study, we examined the effects of inhibition of cyclin-dependent kinase (cdk) activity on viral replication. With the drug Roscovitine, a specific inhibitor of cyclin-dependent kinases 1, 2, 5, 7, and 9, we have shown that during the first 6 h of infection, cyclin-dependent kinase-dependent events occurred that included the regulated processing and accumulation of the immediate-early (IE) UL122-123 transcripts and UL36-37 transcripts. Altered processing of UL122-123 led to a loss of IE1-72 and an increase in IE2-86. The ratio of spliced to unspliced UL37 transcripts also changed. These effects did not require de novo protein synthesis or degradation of proteins by the proteasome. Addition of Roscovitine at the beginning of the infection was also associated with inhibition of expression of selected viral early gene products, viral DNA replication, and late viral gene expression. When Roscovitine was added after the first 6 h of infection, the effects on IE gene expression were no longer observed and viral replication proceeded through the late phase, but viral titers were reduced. The reduction in viral titer was observed even when Roscovitine was first added at 48 h postinfection, indicating that cyclin-dependent kinase activity is required at both IE and late times. Flavopiridol, another specific inhibitor of cyclin-dependent kinases, had similar effects on IE and early gene expression. These results underscore the importance of accurate RNA processing and reiterate the significant role of cell cycle-regulatory factors in HCMV infection.

Small internal deletions in the human cytomegalovirus IE2 gene result in nonviable recombinant viruses with differential defects in viral gene expression

The human cytomegalovirus (HCMV) IE2 86-kDa protein is a key viral transactivator and an important regulator of HCMV infections. We used the HCMV genome cloned as a bacterial artificial chromosome (BAC) to construct four HCMV mutants with disruptions in regions of IE2 86 that are predicted to be important for its transactivation and autoregulatory functions. Three of these mutants have mutations that remove amino acids 356 to 359, 427 to 435, and 505 to 511, which disrupts a region of IE2 86 implicated in the activation of HCMV early promoters, a predicted zinc finger domain, and a putative helix-loop-helix motif, respectively, while the fourth carries three arginine-to-alanine substitution mutations in the region of amino acids 356 to 359. The resulting recombinant viruses are not viable, and by using quantitative real-time reverse transcription-PCR and immunofluorescence we have determined the location of the block in their replicative cycles. The IE2 86 Delta 356-359 mutant is able to support early gene expression, as indicated by the presence of UL112-113 transcripts and UL112-113 and UL44 proteins in cells transfected with the mutant BAC. This mutant does not express late genes and behaves nearly indistinguishably from the IE2 86R356/7/9A substitution mutant. Both exhibit detectable upregulation of major immediate-early transcripts at early times. The IE2 86 Delta 427-435 and IE2 86 Delta 505-511 recombinant viruses do not activate the early genes examined and are defective in repression of the major immediate-early promoter. These two mutants also induce the expression of selected delayed early (UL89) and late genes at early times in the infection. We conclude that these three regions of IE2 86 are necessary for productive infections and for differential control of downstream viral gene expression.

Single- and multistep selection study of the antipneumococcal activity of BMS-284756 compared to ciprofloxacin, levofloxacin, trovafloxacin and moxifloxacin

Single- and Multi-step selection studies were used to test the ability of BMS-284756, ciprofloxacin, levofloxacin, trovafloxacin and moxifloxacin to yield resistant clones from 12 quinolone-susceptible and -resistant Streptococcus pneumoniae strains. Although all quinolones selected, to a greater or lesser degree, for resistant clones with mutations usually in parC or gyrA, BMS-284756 tended to select for resistant clones at a lower rate than other quinolones studied.

Viable human cytomegalovirus recombinant virus with an internal deletion of the IE2 86 gene affects late stages of viral replication

Using bacterial artificial chromosome (BAC) technology, we have constructed and characterized a human cytomegalovirus recombinant virus with a mutation in the exon specific for the major immediate-early region 2 (IE2) gene product. The resulting IE2 86-kDa protein (IE2 86) has an internal deletion of amino acids 136 to 290 and is fused at the carboxy terminus to enhanced green fluorescent protein (EGFP). The deletion also removes the promoter and initiator methionine for the p40 form of IE2 and initiator methionine for the p60 form of the protein, and therefore, these late gene products are not produced. The mutant virus IE2 86 Delta SX-EGFP is viable but exhibits altered growth characteristics in tissue culture compared with a full-length wild-type (wt) IE2 86-EGFP virus or a revertant virus. When cells are infected with the mutant virus at a low multiplicity of infection (MOI), there is a marked delay in the production of infectious virus. This is associated with slower cell-to-cell spread of the virus. By immunofluorescence and Western blot analyses, we show that the early steps in the replication of the mutant virus are comparable to those for the wt. Although there is significantly less IE2 protein in the cells infected with the mutant, there is only a modest lag in the initial accumulation of IE1 72 and viral early proteins, and viral DNA replication proceeds normally. The mutation also has only a small effect on the synthesis of the viral major capsid protein. The most notable molecular defect in the mutant virus infection is that the steady-state levels of the pp65 (UL83) and pp28 (UL99) matrix proteins are greatly reduced. In the case of UL83, but not UL99, there is also a corresponding decrease in the amount of mRNA present in cells infected with the mutant virus.

Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes

OBJECTIVE

To determine whether there was any detectable difference in outcomes of external anal sphincter repair depending on whether patients were managed routinely with a covering stoma, a constipating dietary regimen or a laxative dietary regimen in the early postoperative period.

PATIENTS AND METHODS

A consecutive retrospective series of 299 anal sphincter repairs undertaken on 286 patients within a single institution was studied. Patients were divided into three groups depending on the peri-operative regimen followed: routine use of a covering stoma (group 1), routine use of a postoperative constipating dietary regimen (group 2) and routine use of a laxative dietary regimen (group 3). Choice of peri-operative regimen depended on surgeon preference alone. Short-term outcomes (length of stay, complications) and long-term outcomes (functional reported degree of continence, anal ultrasound and physiology test results) were assessed in relation to peri-operative group as well as aetiology of sphincter damage.

RESULTS

Short-term results (complications of surgery) were obtainable in all patients; long-term results were available for 89% of patients. Length of stay was similar for all 3 groups (excluding re-admission for stoma closure). Complication rates were not significantly different between the three groups. Functional improvement in continence was reported by 68% of group 1, 69% of group 2 and 79% of group 3 (differences not statistically significant). An anatomical sphincter defect was detected postoperatively in 8% of patients in group 1, 9% in group 2 and 7% of group 3. Poorer outcomes were achieved in older patients and in patients with previous ileo-anal pouch formation. Early faecal impaction and repair breakdown were independently associated with poor long-term outcomes.

CONCLUSIONS

Neither routine use of a covering stoma nor a postoperative constipating regimen produced better results following external anal sphincter repair than did the use of a postoperative laxative regimen which encouraged early passage of loose stool without the need for straining.

The use of recombinant baculoviruses for sustained expression of human cytomegalovirus immediate early proteins in fibroblasts

The isolation of viruses with mutations in essential genes requires that they be propagated in cells expressing the wild-type proteins. This has been a particularly challenging problem for studying mutations in the human cytomegalovirus (HCMV) immediate early (IE) gene, IE2 86. In the past, we tried a number of approaches to derive human fibroblasts expressing wild-type IE2 86, but were unable to maintain expression of a fully functional protein. To overcome this obstacle, we developed a strategy whereby recombinant baculoviruses were used as vectors for the expression of HCMV IE proteins in primary human fibroblasts (FFs). The IE2 86 and IE1 72 cDNAs, as well as the genomic fragment of the UL122-123 region under the control of a chicken actin promoter, were introduced into the baculovirus genome by site-specific transposition in Escherichia coli. Recombinant "bacmid" DNAs were then transfected into Sf9 cells to generate recombinant baculoviruses. FFs infected at high m.o.i. with these baculoviruses expressed high levels of the HCMV protein for at least 1 week, as determined by immunofluorescence assays and Western blots. Moreover, the IE2 86 protein was found to be fully functional with respect to its ability to activate the HCMV UL112-113 early promoter. Recombinant baculoviruses expressing IE1 72 were also able to efficiently complement HCMV ie1 mutants. These data demonstrate the potential of using recombinant baculoviruses as vectors for the expression of toxic viral genes in human cells and for subsequent isolation of mutant HCMV lacking these essential genes.

Intimate partner violence and drinking patterns among white, black, and Hispanic couples in the U.S

PURPOSE

Using reports from both partners, this study estimated prevalence rates of intimate partner violence (IPV) among white, black, and Hispanic couples in the U.S., and assessed the contribution of drinking patterns, psychosocial, and other sociodemographic factors to the risk of partner violence.

METHODS

A multistage area probability sample consisting of 555 white, 358 black, and 527 Hispanic couples in the U.S. household population was interviewed in 1995. Logistic regression analyses revealed that predictors of IPV vary by ethnicity.

RESULTS

Rates of male-to-female (MFPV) and female-to-male partner violence (FMPV) were highest among black couples (23% and 30%), followed by Hispanic (17% and 21%), and white couples (12% and 16%). Between 27 percent and 41 percent of the men, and 4 percent and 24 percent of the women were drinking at the time of the violent incident.

IMPLICATIONS

Black and Hispanic couples are at higher risk for IPV than white couples and should be targeted for prevention intervention. The interrelationships among IPV, alcohol consumption, and ethnicity are complex. These findings suggest that future attempts at modeling IPV should be ethnically sensitive and, ideally, include separate analyses of each ethnic group.

Couples' drinking patterns, intimate partner violence, and alcohol-related partnership problems

PURPOSE

Past research has revealed a strong correspondence between alcohol use and family dysfunction (e.g., Straus and Gelles in 1986 and 1990). Unfortunately, much of this research has relied on reports from only one family member.

METHODS

Here, we present the results from a recent, nationwide study of alcohol-consumption patterns, alcohol-related partnership problems, and intimate partner violence (IPV) based on reports from both romantic partners of 1,615 married and cohabiting couples.

RESULTS

Using the "drinking partnerships" construct developed by Roberts and Leonard in 1997, we found that despite considerable concordance between couple members' drinking behaviors, discrepant drinking patterns were strongly predictive of relational distress and the incidence of physical violence.

IMPLICATIONS

These findings suggest that the interaction between couple members' alcohol-related behaviors has crucial implication for the health and well-being of the entire family.

Neurotransmitter release from bovine adrenal chromaffin cells is modulated by capacitative Ca(2+)entry driven by depleted internal Ca(2+)stores

Two potential mechanisms by which the intracellular Ca(2 stores might modulate catecholamine release from bovine adrenal chromaffin cells were investigated: (i) that the cytosolic Ca(2+)transient caused by Ca(2+)release from the intracellular stores recruits additional chromaffin granules to a readily releasable pool that results in augmented catecholamine release when this is subsequently evoked, and (ii) that the Ca(2+)influx that follows depletion of intracellular stores (i.e. store-operated Ca(2+)entry) triggers release per se thereby augmenting evoked catecholamine release. When histamine or caffeine were applied in Ca(2+)-free perfusion media, a transient elevation of intracellular free Ca(2+)occurred owing to mobilization of Ca(2+)from the stores. When Ca(2+)was later readmitted to the perfusing fluid there followed a prompt and maintained rise in intracellular Ca(2+)concentrations of magnitude related to the degree of store mobilization. In parallel experiments, increased catecholamine secretion was measured under the conditions when Ca(2+)influx following store-mobilization occurred. Furthermore, the size of the catecholamine release increment correlated with the degree of Ca(2+)influx. Store-operated Ca(2+)entry evoked by mobilization with histamine and/or caffeine did not augment nicotine-evoked secretion per se; that is, it augmented evoked catecholamine release only to the extent that it increased basal catecholamine release. The nicotine-evoked catecholamine release was sensitive to cytosolic BAPTA, which, at the concentration used (50 microM BAPTA-AM), reduced release by approximately 25%. However, the increment in basal catecholamine release which followed Ca(2+)influx triggered by Ca(2+)store mobilization was not reduced by intracellular BAPTA. This finding is inconsistent with the hypothesis that the elevated cytosolic Ca(2+)from store mobilization recruits additional vesicles of catecholamine to the sub-plasmalemmal release sites to augment subsequently evoked secretion. This position is supported by the observation that histamine (10 microM) in Ca(2+)-free medium caused a pronounced elevation of cytosolic free Ca(2+), but this caused no greater catecholamine release when Ca(2+)was re-introduced than did prior exposure to Ca(2+)-free medium alone, which caused no elevation of cytosolic free Ca(2+). It is concluded that intracellular Ca(2+)stores can modulate secretion of catecholamines from bovine chromaffin cells by permitting Ca(2+)influx through a store-operated entry pathway. The results do not support the notion that the Ca(2+)released from intracellular stores plays a significant role in the recruitment of vesicles into the ready-release pool under the experimental conditions reported here.

Education provision for surgical senior house officers

The provision of formal education in surgical SHO training is a requirement for posts to be accredited by postgraduate deans. We carried out a questionnaire survey of surgical SHOs attending a Royal College of Surgeons of England study day to quantify the amount of time given to formal education and supervised operating. We found that 79% of SHOs at district general hospitals and 87.5% at teaching hospitals were provided with a formal education programme. Of these SHOs, 77% were able to attend the teaching on a regular basis. In an average week, 8% of SHOs received no supervised operating experience and 37% had no operations supervised by a consultant. These results suggest that many hospitals fall short of the accepted guidelines on basic surgical training. This issue must be addressed by the Royal Colleges.

Impact on medical students of incorporating GALS screen teaching into the medical school curriculum

OBJECTIVE

To assess the impact of GALS locomotor screen teaching to all 3rd year medical students, at a British medical school.

METHOD

In 1998, during their 3rd year, all students were taught the GALS screen in a one hour small group session. At the end of this year, 242 medical students undertook a 16 station Objective Structured Clinical Examination (OSCE). One station assessed the locomotor screening examination, while six stations assessed the examination of other systems. The students completed a five point likert scale, self rating their confidence in each of the skills assessed at this time. Pre-registration house officers (PRHOs) at two London hospitals were invited to undertake the same OSCE and self rating.

RESULTS

The students performed the locomotor screen well (mean station score 80%). Three body systems were examined better and one significantly worse (p<0.05). 22/40 PRHOs undertook the assessment. Compared with the students they examined the locomotor system (mean score 20%, p<0.001), but not other systems, less well. The PRHOs felt less confident (p<0.05) examining the locomotor system (mean rating 3.6/5) than the other systems (mean rating 4.6/5), while no significant difference in confidence ratings was seen for the students.

CONCLUSION

Students who are taught the GALS screen as part of the curriculum, perform it well in an end of year OSCE, as confidently as other systems, and to a higher standard than PRHOs. Further study is required to determine whether this benefit persists, overcoming the poor skills and confidence in locomotor examination of existing PRHOs, not previously taught a GALS screen.

Activities and postantibiotic effects of gemifloxacin compared to those of 11 other agents against Haemophilus influenzae and Moraxella catarrhalis

The activity of gemifloxacin against Haemophilus influenzae and Moraxella catarrhalis was compared to those of 11 other agents. All quinolones were very active (MICs, </=0.125 microgram/ml) against 248 quinolone-susceptible H. influenzae isolates (40.7% of which were beta-lactamase positive); cefixime (MICs, </=0.125 microgram/ml) and amoxicillin-clavulanate (MICs </=4.0 microgram/ml) were active, followed by cefuroxime (MICs, </=16.0 microgram/ml); azithromycin MICs were </=4.0 microg/ml. For nine H. influenzae isolates with reduced quinolone susceptibilities, the MICs at which 50% of isolates are inhibited (MIC(50)s) were 0.25 microgram/ml for gemifloxacin and 1.0 microgram/ml for the other quinolones tested. All strains had mutations in GyrA (Ser84, Asp88); most also had mutations in ParC (Asp83, Ser84, Glu88) and ParE (Asp420, Ser458), and only one had a mutation in GyrB (Gln468). All quinolones tested were equally active (MICs, </=0.06 microgram/ml) against 50 M. catarrhalis strains; amoxicillin-clavulanate, cefixime, cefuroxime, and azithromycin were very active. Against 10 H. influenzae strains gemifloxacin, levofloxacin, sparfloxacin, and trovafloxacin at 2x the MIC and ciprofloxacin at 4x the MIC were uniformly bactericidal after 24 h, and against 9 of 10 strains grepafloxacin at 2x the MIC was bactericidal after 24 h. After 24 h bactericidal activity was seen with amoxicillin-clavulanate at 2x the MIC for all strains, cefixime at 2x the MIC for 9 of 10 strains, cefuroxime at 4x the MIC for all strains, and azithromycin at 2x the MIC for all strains. All quinolones except grepafloxacin (which was bactericidal against four of five strains) and all ss-lactams at 2x to 4x the MIC were bactericidal against five M. catarrhalis strains after 24 h; azithromycin at the MIC was bactericidal against all strains after 24 h. The postantibiotic effects (PAEs) against four quinolone-susceptible H. influenzae strains were as follows: gemifloxacin, 0.3 to 2.3 h; ciprofloxacin, 1.3 to 4.2 h; levofloxacin, 2.8 to 6.2 h; sparfloxacin, 0.6 to 3.0 h; grepafloxacin, 0 to 2.1 h; trovafloxacin, 0.8 to 2.8 h. At 10x the MIC, no quinolone PAEs were found against the strain for which quinolone MICs were increased. Azithromycin PAEs were 3.7 to 7.3 h.

Hispanics, Blacks and White driving under the influence of alcohol: results from the 1995 National Alcohol Survey

OBJECTIVE

To report nationwide survey data on patterns of driving under the influence of alcohol among Whites, Blacks and Hispanics.

METHOD

Data were obtained from a probability sample consisting of 1582 Blacks, 1585 Hispanics and 1636 Whites in the US household population. Interviews averaging 1 h in length were conducted in respondents' homes by trained interviewers.

RESULTS

Self-reported rates of driving a car after having drunk enough 'to be in trouble if stopped by the police' were highest among White and Hispanic men (22 and 21%, respectively), as were lifetime arrest rates for driving under the influence of alcohol (13% for White men, 19% for Hispanic men). Additionally, our analyses suggest that drinkers who drive under the influence of alcohol are more likely to be men (regardless of ethnicity), consume more alcohol, and be alcohol dependent than drinkers who do not engage in alcohol-impaired driving.

Alcohol-related problems and intimate partner violence among white, black, and Hispanic couples in the U.S

OBJECTIVES

This study analyzes gender and ethnic/racial differences in the prevalence of alcohol-related problems among white, black and Hispanic couples in the United States, and assesses their contribution to the risk of intimate partner violence (IPV).

METHODS

Our study population consisted of 1440 white, black, and Hispanic couples obtained through a multistage area household probability sample from the 1995 National Alcohol Survey. Alcohol-related problems (i.e., drinking consequences and alcohol dependence symptoms in the last 12 months) were assessed among respondents and their partners. Male-to-female and female-to-male partner violence (MFPV, FMPV) were measured separately using the Conflict Tactics Scale.

RESULTS AND CONCLUSIONS

Alcohol-related problems were more prevalent among men than women. Our bivariate analysis demonstrated a significant positive association between male alcohol-related problems and IPV across racial/ethnic groups, and a similar association between female alcohol-related problems and IPV for white and black couples. In the multivariate logistic regression analyses, however, many of these associations were attenuated. After controlling for sociodemographic and psychosocial covariates, male alcohol-related problems were no longer significantly associated with an increased risk of MFPV among white or Hispanic couples. Female alcohol-related problems predicted FMPV, but not MFPV, among white couples. Among black couples, however, male and female alcohol-related problems remained strong predictors of intimate partner violence.

SIGNIFICANCE

Alcohol-related problems are important predictors of intimate partner violence, and the exact association between problems and violence seems to be ethnic-specific. Alcohol-related problems, rather than level of alcohol consumption, may be the more relevant factor to consider in the alcohol-partner violence association. Future research is needed to explore the temporal relationships between the development of alcohol-related problems and the occurrence of partner violence.

Activities of clinafloxacin, alone and in combination with other compounds, against 45 gram-positive and -negative organisms for which clinafloxacin MICs are high

Time-kill studies indicated that clinafloxacin showed synergy after 24 h with ceftazidime, amikacin, and imipenem against 12, 8, and 10 of 33 gram-negative rods, respectively; with vancomycin, teicoplanin, cefotaxime, and amikacin against 3, 3, 1, and 1 of 9 staphylococci and enterococci, respectively; and with vancomycin, penicillin, and cefotaxime against 0, 2, and 2 of 3 pneumococci, respectively. The MICs of clinafloxacin alone for most strains were >/=1 microg/ml.

Trends in situational norms and attitudes toward drinking among whites, blacks, and hispanics: 1984-1995

The purpose of this study was to explore trends in situational norms and attitudes toward drinking and to assess the associations of norms and attitudes with current drinking and frequent heavy drinking patterns among whites, blacks, and hispanics between 1984 and 1995. Data were obtained from two nationwide probability samples of US households. Results indicated that there were no broad trends in situational norms and attitudes toward drinking between 1984 and 1995 among whites, blacks, and hispanics in the US. The variations in norms and attitudes detected between 1984 and 1995 were ethnic and gender-specific. For all of the groups studied, situational norms and attitudes were highly predictive of both current drinking and frequent heavy drinking patterns.

Antipneumococcal activities of levofloxacin and clarithromycin as determined by agar dilution, microdilution, E-test, and disk diffusion methodologies

The activities of levofloxacin and clarithromycin against 199 penicillin- and macrolide-susceptible and -resistant pneumococci were tested by agar and microdilution methods in air and by disk diffusion and E-test methods in air and CO2. For levofloxacin, >/=99. 0% of strains were susceptible at /=17 mm, regardless of incubation in air or CO2. Although zone sizes were smaller and E-test MICs were higher for clarithromycin in CO2 than those in air, category differences were minor, and susceptibility rates for clarithromycin were similar to those obtained by agar and microdilution in air (range, 76.9 to 80.9% by all methods). For clarithromycin, adjustment of breakpoints based upon distribution of results resulted in susceptibility rates which were similar by all methods (75.8 to 76.9% susceptible, 0 to 1.5% intermediate, 22.6 to 23.1% resistant). Minor discrepancies were obtained with levofloxacin for one strain (0.5%) by microdilution and two strains (1.0%) by disk diffusion in CO2. For clarithromycin, minor discrepancies were found in three strains (1.5%) by microdilution, seven strains (3.5%) by agar dilution, four strains (2.0%) by E-test in air, six strains (3.0%) by disk diffusion in air, and five strains (2.5%) by disk diffusion in CO2. Major discrepancies occurred with levofloxacin in one strain (0.5%) by microdilution but were not found with clarithromycin. Very major discrepancies were not seen with levofloxacin, but occurred with clarithromycin in five strains (2.5%) by microdilution, three strains (1.5%) by agar dilution, two strains (1.0%) by E-test in air, eight strains (4.0%) by disk diffusion in air, and one strain (0.5%) by disk diffusion in CO2.

Rates of intimate partner violence in the United States

OBJECTIVES

Estimates of intimate partner violence in the United States based on representative samples have relied on data from one person per household or limited numbers of indicators from both partners. The purpose of this study was to estimate nationwide rates of intimate partner violence with data from both couple members by using a standardized survey instrument, the Conflict Tactics Scale.

METHODS

A multistage probability sampling design was used to conduct separate face-to-face interviews in respondents' homes with both members of 1635 representative couples living in the 48 contiguous states.

RESULTS

Both partners' reports were used to estimate the following lower- and upper-bound rates: 5.21% and 13.61% for male-to-female partner violence, 6.22% and 18.21% for female-to-male partner violence, and 7.84% to 21.48% for any partner-to-partner violence.

CONCLUSIONS

High rates of intimate partner violence in the United States corroborate previous claims that the amount of intimate partner violence is substantial.

Trends in alcohol consumption patterns among whites, blacks and Hispanics: 1984 and 1995

OBJECTIVE

To report national trends in alcohol consumption patterns among whites, blacks and Hispanics between 1984 and 1995, in relation to the recent decline in per capita consumption in the United States.

METHOD

Data were obtained from two nationwide probability samples of U.S. households, the first conducted in 1984 and the second in 1995. The 1984 sample consisted of 1,777 whites, 1,947 blacks and 1,453 Hispanics; the 1995 sample consisted of 1,636 whites, 1,582 blacks and 1,585 Hispanics. On both occasions, interviews averaging 1 hour in length were conducted in respondents' homes by trained interviewers.

RESULTS

Between 1984 and 1995, the rate of abstention remained stable among whites but increased among blacks and Hispanics. Frequent heavy drinking decreased among white men (from 20% to 12%), but remained stable among black (15% in both surveys) and Hispanic men (17% and 18%). Frequent heavy drinking decreased among white women (from 5% to 2%), but remained stable among black (5% in both surveys) and Hispanic women (2% and 3%). White men and women were two times more likely to be frequent heavy drinkers in 1984 than in 1995.

CONCLUSIONS

The reduction in per capita consumption in the U.S. is differentially influencing white, black and Hispanic ethnic groups. The stability of rates of frequent heavy drinking places blacks and Hispanics at a higher risk for problem development than whites. This finding is, therefore, a concern to public health professionals and others interested in the prevention of alcohol-related problems among ethnic groups in the United States.

Separate DNA elements containing ATF/CREB and IE86 binding sites differentially regulate the human cytomegalovirus UL112-113 promoter at early and late times in the infection

The human cytomegalovirus (HCMV) UL112-113 promoter represents a useful model for studying temporal regulation of viral gene expression. Stimulation of this promoter by the 86-kDa immediate-early protein (IE86) is controlled by sequences between nucleotides -113 and -59, which include both an ATF/CREB and an IE86 binding site. In transient assays, the ATF/CREB site is essential, and the IE86 site, although nonessential, can enhance transcription. With recombinant viruses, we have assessed the function of these promoter elements in the context of the viral genome. Transcription from the inserted UL112-113 promoter shows the same temporal pattern as the endogenous promoter, including the switch to an upstream RNA start site late in infection. Deletion of sequences containing the IE86 site results in a decrease in the level of early transcription and elimination of late transcription. In contrast, when the ATF/CREB site is deleted, early RNA synthesis is almost completely abolished, but late transcription is comparable to that of the wild type, with repositioning of the RNA start site downstream by the number of nucleotides deleted. Replacement of sequences between -108 and -95 with the HCMV cis-repression signal from the major immediate-early promoter had no effect on the level of late RNAs but resulted in the repositioning of the RNA start site 39 nucleotides upstream. These results suggest that the ATF/CREB site is functional only at early times, while sequences containing the IE86 site modulate the level of early RNAs and may be required for activating late transcription in a distance-dependent manner.

Trends in alcohol-related problems among whites, blacks, and Hispanics: 1984-1995

The objective of this study was to report trends in alcohol problems among whites, blacks, and Hispanics between 1984 and 1995. Data were obtained from two nationwide probability samples of U.S. households, the first conducted in 1984 and the second in 1995. The 1984 sample consisted of 1777 whites, 1947 blacks, and 1453 Hispanics. The 1995 sample included 1636 whites, 1582 blacks, and 1585 Hispanics. On both occasions, interviews (average length, 1 hr) were conducted in respondents' homes by trained interviewers. The results indicate that between 1984 and 1995, alcohol problems were stable among white and black men and increased among Hispanic men. The rates of three or more alcohol problems for men of each ethnic group for 1984 and 1995 were: 12% and 11% for white men, 16% and 13% for black men, and 9% and 16% for Hispanic men, respectively. Problem prevalence was stable and relatively low among women in all three ethnic groups. Overall, the prevalence of alcohol problems continues to be high among men in the United States. Even though recent research has shown that rates of frequent heavy drinking among white men have declined, we found no corresponding decrease in problem prevalence. Rates of frequent heavy drinking and alcohol-related problems between 1984 and 1995 have remained especially high among black and Hispanic men, suggesting that men of these two ethnic groups should be specifically targeted for renewed prevention efforts.

Alcohol consumption among racial/ethnic minorities: theory and research

Ethnic minorities (e.g., Hispanics, blacks, Asian-Americans, and Native Americans) are still underrepresented in alcohol research in the United States. Furthermore, existing studies often do not take into consideration the variability that exists within each ethnic group, resulting in inaccurate generalizations. Studies among Hispanics have found substantial differences among Hispanic subgroups in drinking patterns and rates of alcohol-related problems. Moreover, no single variable can explain the observed patterns. Similarly, numerous factors have been shown to shape drinking patterns among blacks, including individual and environmental characteristics as well as historical and cultural factors. Different subgroups of Asian-Americans also vary substantially in their rates of drinking and heavy drinking, although their lifetime alcohol use is lower than the national average. Genetic and cultural factors, as well as stress and historic experiences, may influence drinking patterns of Asian-Americans. The widely differing drinking patterns among Native Americans also are likely shaped by a variety of influences.

Prevalence, trends, and incidence of alcohol withdrawal symptoms: analysis of general population and clinical samples

Analyses of the prevalence and incidence of withdrawal symptoms in the general population can provide an estimate of the frequency of alcohol dependence in the population. Similar analyses in people who are being treated for alcoholism or alcohol-related problems can identify the need for and specific types of treatment required for these populations. Three national surveys found that the prevalence of withdrawal symptoms was relatively low in the general population and has remained stable over the past 15 years. The likelihood of experiencing withdrawal symptoms increased with increasing alcohol consumption. No differences in the prevalence of withdrawal symptoms existed among ethnic groups in the general population. In a sample of patients undergoing alcoholism treatment, the prevalence of withdrawal symptoms generally was high, with lower rates among blacks than among whites and Hispanics. The prevalence of withdrawal symptoms in people undergoing treatment after being convicted of driving under the influence fell between that of the general population and that of the treatment sample.

CD, absorption and thermodynamic analysis of repeating dinucleotide DNA, RNA and hybrid duplexes [d/r(AC)]12.[d/r(GT/U)]12 and the influence of phosphorothioate substitution

Circular dichroism (CD) spectra and melting temperature (Tm) data for five duplexes containing phosphorothioate linkages were compared with data for four unmodified duplexes to assess the effect of phosphorothioate modification on the structure and stability of DNA. DNA and DNA.RNA duplexes. Nine duplexes were formed by mixing oligomers 24 nt long in 0.15 M K+(phosphate buffer), pH 7.0. Unmodified DNA.DNA and RNA.RNA duplexes were used as reference B-form and A-form structures. The CD spectra of the modified hybrids S-d(AC)12.r(GU)12 and r(AC)12.S-d(GT)12 differed from each other but were essentially the same as the spectra of the respective unmodified hybrids. They were more A-form than B-form in character. CD spectra of duplexes S-d(AC)12.d(GT)12 and d(AC)12.S-d(GT)12 were similar to that of d(AC)12.d(GT)12, except for a reduced long wavelength CD band. Sulfur modifications on both strands of the DNA duplex caused a pronounced effect on its CD spectrum. The order of thermal stability was: RNA.RNA > DNA.DNA > DNA.RNA > S-DNA.DNA > S-DNA. RNA > S-DNA.S-DNA. Phosphorothioation of one strand decreased the melting temperature by 7.8+/-0.6 degrees C, regardless of whether the substitution was in a hybrid or DNA duplex. Thermodynamic parameters were obtained from a multistate analysis of the thermal melting profiles. Interestingly, the destabilizing effect of the phosphorothioate substitution appears to arise from a difference in the entropy upon forming the DNA.DNA duplexes, while the destabilizing effect in the DNA.RNA hybrids appears to come from a difference in enthalpy.

Safely withdrawing patients from chronic glucocorticoid therapy

The withdrawal of patients from chronic glucocorticoid therapy can be a vexing problem. Symptoms of adrenal insufficiency are often subtle, and the potential complications of too-rapid withdrawal are catastrophic. The increased use of inhaled, intranasal and "superpotent" topical preparations will place more and more patients at risk for hypocortisolism. This article presents a safe, practical algorithmic approach to steroid withdrawal that can be determined in the physician's office. The recognition that patients are on maintenance steroid therapy should prompt a constant reevaluation of the need for such therapy, including consideration of an alternate-day drug regimen. The keys to success in withdrawing patients from steroid therapy include improving patient awareness of the signs and symptoms of steroid withdrawal, close follow-up and correct performance of the cosyntropin challenge, which is safe, practical and reliable. During the steroid withdrawal period, it is extremely important that the patient be proactive in identifying subtle symptoms and bringing them to the physician's attention.

Potential availability of patients in a short stay ward for medical student teaching

The trend towards shorter hospital in-patient stays has decreased the availability of patients for undergraduate medical student teaching. We surveyed 100 consecutive short stay surgical inpatients admitted to hospital on the day of planned operation to determine whether they might be available for student teaching before surgery. We found that there was a median delay of three hours (standard deviation +/-2.3 hours) between the completion of all medical and nursing procedures and the departure of the patient for the operating theatre. All patients were asked if they would agree in principle to participate in student teaching. 98 per cent said they would be willing to be taught upon. We argue that surgical patients attending the short stay ward are a valuable potential source of teaching material.

Complications of gastroesophageal reflux disease. Esophagitis, acid laryngitis, and beyond

Gastroesophageal reflux disease is a common disorder that can result in various esophageal and extraesophageal complications. Reflux of gastric contents can cause esophageal mucosal abnormalities, such as ulcers and peptic strictures, as well as pulmonary and otolaryngologic symptoms, including reflux-induced asthma and acid laryngitis. Left untreated, some complications can lead to more severe disorders, such as esophageal adenocarcinoma that develops in patients with Barrett's esophagus. Accurate recognition of these diverse manifestations allows improved identification of patients at risk for reflux-related disorders and aids in proper evaluation and treatment.

Identification, analysis, and evolutionary relationships of the putative murine cytomegalovirus homologs of the human cytomegalovirus UL82 (pp71) and UL83 (pp65) matrix phosphoproteins

We have identified three open reading frames (ORFs) in murine cytomegalovirus (MCMV), designated M82, M83, and M84, which likely encode homologs of the human cytomegalovirus (HCMV) UL82 and UL83 matrix phosphoproteins. These ORFs, in the HindIII C fragment of MCMV, are colinear with the UL82, UL83, and UL84 ORFs of HCMV. M82 encodes a 598-amino-acid (aa) protein with homology to UL82, M83 encodes an 809-aa protein with homology to UL82 and UL83, and M84 encodes a 587-aa protein with homology to UL83 and UL84. Analysis of transcription by Northern (RNA) blotting indicated that the M82 and M83 ORFs are transcribed as 2.2- and 5-kb mRNAs, respectively, at 24 to 48 h postinfection (p.i.), while M84 is transcribed as a 6.9-kb mRNA only at 8 h p.i. All transcripts appear to terminate at the same position 3' of the M82 ORF. Of the products of the three ORFs, only M83 is strongly recognized by hyperimmune mouse serum. The M83 protein is a virion-associated phosphoprotein with an apparent molecular mass of 125 kDa. In MCMV-infected cells, it is detectable by Western blotting (immunoblotting) only at 48 h p.i. in the absence of phosphonoacetic acid, consistent with late gene expression. The M83 ORF is also expressed at high levels in cells infected by a recombinant vaccinia virus and yields a protein which is serologically cross-reactive and comigrates with the authentic MCMV protein in sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

The immune response in small bowel transplantation

The immunological problems of small bowel transplantation have not yet been overcome. Frequent severe rejection episodes are common in clinical practice, and GVHD may emerge as a significant complication once rejection is more effectively controlled. Both are caused by the large number of lymphocytes in the graft. There is extensive exchange migration of lymphocytes between graft and host even in the absence of rejection, and persisting donor cells in the host may carry the propensity for GVHD. Various techniques including analysis of host peripheral blood samples are being developed to enable earlier and easier diagnosis of rejection, which should facilitate early treatment and reduce infective complications. The balance between rejection and GVHD can be manipulated experimentally, and clinical trials are under way to determine whether such techniques can improve the outcome for human transplant recipients.

Evidence that orthotopic transposition following rat heterotopic small bowel transplantation corrects overgrowth of potentially pathogenic bacteria

An overgrowth of pathogenic organisms occurs following rat heterotopic small bowel transplantation. This study assessed whether the bacterial microflora return to normal following subsequent orthotopic transposition of the graft. After 14 days the heterotopic graft was placed into continuity following resection of 15 cm of the host midintestinal loop. Quantitative and qualitative analyses of the intraluminal bacteria were performed studying the resected host intestine, the heterotopic graft at 14 days, and the graft 14 days after transposition. A group of normal rats were used as controls. An overgrowth of Staphylococcus epidermidis evident in the heterotopic graft at 14 days returned to a more normal bacterial profile following orthotopic transposition. These findings suggest that early interposition of a small bowel graft into an orthotopic position may prevent an alteration in the small bowel ecology toward potentially pathogenic organisms capable of translocation.

Depleted internal store-activated Ca2+ entry can trigger neurotransmitter release in bovine chromaffin cells

A potential role of the intracellular Ca2+ stores in modulating catecholamine release has been investigated in bovine chromaffin cells maintained in tissue culture. Pharmacological depletion of the stores with a combination of caffeine, histamine and thapsigargin in Ca2+-free media resulted in a significantly greater release of catecholamines on re-exposure to Ca2+-containing media compared with that from non-store depleted cells. The increase in catecholamine release was prevented by intracellular BAPTA indicating that the increase was caused by a rise in Ca2+. Measurement of intracellular free Ca2+ concentration with the fluorescent indicator, fura-2, over the same time-course as the catecholamine release experiments showed that upon restoration of external Ca2+ there was an immediate, substantial and maintained increase in cytosolic Ca2+. It is most probable that the increase in catecholamine release was a consequence of an increase in Ca2+ influx triggered by prior depletion of the internal Ca2+ stores. However, the data suggest that capacitative Ca2+ entry is poorly linked to catecholamine release; although Ca2+ entry on restoration of external Ca2+ was immediate and substantial, the increase in catecholamine release, although quantitatively significant, was slowly realised.

A difference in the cellular mechanisms of secretion of adrenaline and noradrenaline revealed with lanthanum in bovine chromaffin cells

A comparison of the effectiveness of the trivalent cation, lanthanum (La3+) relative to Ca2+ in causing adrenaline and noradrenaline release from bovine adrenal medullary chromaffin cells has been made. In cells maintained in tissue culture and permeabilised with digitonin, both La3+ and Ca2+ triggered catecholamine release. La3+ was more effective than Ca2+: the EC50 for La3+ was shifted to the left of that for Ca2+ by close to one order of magnitude for both adrenaline and noradrenaline. With respect to adrenaline, the same maximal release was triggered by the two cations, but with respect to noradrenaline, La3+ triggered a significantly greater release than did Ca2+. Mixtures of experimental media containing both La3+ and Ca2+ caused release of adrenaline and noradrenaline in amounts that approximated closely the sum of the releases caused by Ca2+ and La3+ alone. The data strongly imply that either the release mechanisms for adrenaline and for noradrenaline from their respective chromaffin cells are different, or the cellular mechanisms that regulate release from the two cells are different.

Presence and localization of tumor necrosis factor alpha in the corpus luteum of nonpregnant and pregnant pigs

The objectives of this study were to determine whether tumor necrosis factor alpha (TNF alpha) is present in porcine corpus luteum (CL) and, if so, to ascertain which cells of the CL were associated with TNF alpha. The influence of the reproductive state of the animals on the amount or cellular localization of TNF alpha in the CL was also investigated. Western blot analysis demonstrated the presence of a 34-kDa immunoreactive TNF alpha-like protein in CL from nonpregnant and pregnant pigs. The intensity of TNF alpha immunostaining in bands observed in Western blots did not differ when luteal protein from nonpregnant pigs or from pregnant pigs was analyzed. Positive immunostaining for TNF alpha, determined by immunocytochemistry, was localized within endothelial cells of luteal sections. Positive immunocytochemical staining was recorded in all reproductive states examined except in CL that had undergone functional luteolysis (reduced progesterone concentration). A single-cell assay for TNF alpha secretion (a reverse hemolytic plaque assay) confirmed in vitro secretion of TNF alpha by a cell type in luteal tissue with a size and nuclear morphology similar to an endothelial cell. The presence of TNF alpha in the endothelial cells in functional CL is consistent with a role for TNF alpha in the regulation of vascular development of the CL in swine.

Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial

OBJECTIVE

To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support.

DESIGN

Prospective clinical trial.

SETTING

A 455-bed tertiary care institution, with Level I trauma designation.

PATIENTS

Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of < 3 mg/dL (< 0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity.

INTERVENTIONS

Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (< 1.5 mg/dL [< 0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days.

MEASUREMENTS AND MAIN RESULTS

Sixty-seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 +/- 0.6 to 3.3 +/- 0.6 mg/dL (0.84 +/- 0.19 to 1.1 +/- 0.19 mmol/L) for the mild group; 1.9 +/- 0.6 to 2.7 +/- 0.6 mg/dL (0.61 +/- 0.19 to 0.87 +/- 0.19 mmol/L) for the moderate group; 1.3 +/- 0.8 to 2.3 +/- 0.8 mg/dL (0.42 +/- 0.26 to 0.74 +/- 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period.

CONCLUSION

The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.